EX-4.3 4 u06480f3exv4w3.htm EX-4.3 EX-4.3
Exhibit 4.3
 
(Proxy Card)
HSBCH OLDINGS SUBSCRIPTION AND INSTRUCTION FORMInvestor ID NumberTHIS SUBSCRIPTION AND INSTRUCTION FORM, N I CLUDING THE ACCOMPANYING INSTRUCTIONS, SHOULD BE READCAREFULLY BEFORE THIS FORM S I COMPLETED.HSBC Holdings plc has granted o t holders of t i s American Depositary Shares “ ( ADS”) as of March13, 2009 (th e “Record Date”) if ve rights (“ADS Rights) f o r each 12 ADSs held on the RecordDate. Each ADS Right entit e l s the holder o t purchase one new ADS at the U.S. dollar equivalentof each. Al entitlements are o r unded down o t h t e nearest whole ADS Right. No f r actional ADS Rights will be distributed. Holders wishing o t exercise ADS Rights must deposit $19.53 pernew ADS ( t he D “ eposit Amount”) t o account o f r possible exchange rate fluctuations,applicable U.K. stamp duty e r serve tax of 1.5% payable by the ADS holder exercising his/her ADSrights and applicable currency conversion expenses. Any surplus u f nds wil be e r funded. If thereshould be a deficiency, you will be e r quired t o pay it before you receive your new ADSs.For a more complete description of the t e rms and conditions of h t e Rights Of ering, pleaserefer o t h t e Prospectus dated March 17, 2009 (the “Prospectus”), which is in corporated here inby r e ference. Copies of the Prospectus are available upon e r quest r f om BNY Mellon ShareownerServices (to ll r f ee (866) 208-3310).I hereby r i revocably give t h e instructio ns indicated on h t is f o rm upon h t e e t rms andconditions specified in h t e Prospectus. Receipt of h t e Prospectu s s i hereby acknowledged.PLEASE CERTI FY YOUR TAXPAYER ID ENTIFICAT O I NNUMBER ( T IN ) BYCOMPLETING THE INFORMATION IN BOX NUMB ER F ONTHE REVERSE SIDE.SEE N I STRUCTIONSON THE REVERSE SIDEB NUMBER OF NEW ADSsSU BSCRIBED FORWHOLE ADSsA Sig nature: This form must be signed by h t e e r gistered holder(s ) exac tly as t heir name(s)appears on the certif icate(s) C NUMBER OF ADS RIGHTS or by person(s) aut horize d t o sign on behaf l of t h e registered hol der(s ) by documen ts r t an smit e t d herewith. SURRENDERED FOR DELIVERYOF UNDER LYINGORDIN ARY WHOLEADSs RIGHTSXSH ARE RIGHTS Signature of ADS holder Date Daytime Telephone #NUMBER OF ADS RIGHTSTO B E D OFFERED FOR SALEX Signature of ADS holder Date Daytime Telephon e # WHOLE ADS RIGHTSOPTION 4 ABOVE EX PIRESAT5 :00 P .M., NEW YORKCITY TIME,O N MARCH3 0,2009. ESUBSCRIPTION CERTIFICATE NUMBER CUSIP NUMBERNEW ADSs TO SUBSCRIBE ADS RIGHTS RECORD DATE ADSsHSBC HOLDINGS ADSRIGHTS OFFERINGA. Number of New ADSs subscribed for : New ADSsB. Tota l Deposit Amount (li ne A multip lie d by $19.53): $ C. Meth od of Payment.(1) Certifi ed or Cashier’s check or money orderp ayable to BNYM ellon Shareowner Services(acting on behalf of The Bank ofN ew York Mellon).A personal checkw ill notb e accepted.HOW TO CONTACT BNY MELLON SHAREOWNER SERVIC ESBy Telephone - 9 a.m.t o 6 p.m. NewY ork Time, Monday through Friday,exceptf or bank holidays:From wit hin the U.S., Canada or Puerto Rico 1-866-208-3310 (T oll Free) From outside the U.S.1-201-680-6579 (C olle ct)SUBSCRIP TION TO PURCHASEN EW ADSs OF HSBC HOLDIN GSRETURN TO: THE BANKO FN EW YORK MELLON C/O BNYM ELLON SHAREOWNER SERVICESWHERE TOF ORWARDY OUR SUBSCRIP TIO N MATERIALSByM ail : By Overnight Couriero r By Hand:BNYM ellon Share owner Serv ices BNYM ellonS hareowner Services Attn :C orporateActio n Dept., 27 th Floor Attn : Corporate ActionD ept., 27 thFlo or P.O. Box 3301 480W ashingto n Boulevard SouthH ackensack, NJ 07606JerseyC ity ,N J0 7310THIS ADS RIGHTS OFFERIN G EXPIRES AT 5:00 P.M.,N EW YORK CITYT IME, ON MARCH 31, 2009 AND THISSUBSCRIPTION CERTIFICATE S I V OIDT HEREAFTER. YOUR SUBSCRIPTION MATERIALS MUST BE RECEIVEDB YTHESE DATES IN ORDER TO BE VALID.


 

(proxy card)
F SUBSTITUTE FORM W-9 - Department of the Treasury, w Internal Revenue Service Payer’sRequest for Taxpayer Identification Number (TIN)FILL IN t h espace below. CREST Participant ID:Pa r t 1 -PLEAS E PROVI DE Y OU R TAX PAYE R ID ENT F I ICATIO N NUMBER (“TIN “ ) I N THE BOXAT TH E RI GHT AND CERTIF Y BYS I G NING ANDDATING BELOWCREST MemberA ccount ID:Under penalties ofperjury. I certify h tat:1. The number shown on this form is EXEMPT PAYEE Full Name of CRESTA ccount:my correct taxpayer identification numb er(or I am wait ing for a number to be issuedto me), andPlea se check appropriate box:Individ ual/ Sole proprie o t r U.K. Receiving BrokerN ame:2. I am not subject to backu p wit hholdingbecause: ( a ) I am Corp ora tio n Part nership exempt from backup withholding, or ( b )Ihave not beenLim ited liabilit y company U.K. Receiving BrokerC onta ct:notified by the Internal Revenue Service (IRS) that Iam subject to backup withholding as a result of a Enterth e tax cla ss ficatio i n D=disregarded entit y f ailu re to report all inte rest ordividends, o r (c) t h e I RS has Receiv ing Broker PhoneN umber: notified me t hat I am no longer C=corp or atio nP=partners hip subject to backup withholding, andOther U.S. BrokerN ame:3. I am a U.S.citizen or otherU.S. person(including a U.S. er sident alien).U.S. BrokerC ontact:Signature Date U.S. BrokerP honeN umber:COMPLETE ALL APPLICABLE SECTIONS OF THIS FORM USING THE INSTRUCTIONS BELOW.A Sig n and date Box 1a ndi nclude your day time phonen umber.B Place an X in the box and fill int hen umber of whole New ADSy ou wish to subscribe forC Pla ce an X in the box and fil in the number of whole ADS Rights you wish to surrender fordelivery of underlying ordinary share rights andc omplete the deliv ery instruction box in 7 below.D Pla ce an X n i the box and fill in the number of ADS Rights you wisht o offer for s ale. PLEASENOTE, IF YOU SELECT THISOPTION, YOU MUST ENSURE DELIVERY OF THIS SUBSCRIPTION FORM TO THE BANK OF NEW YORK MELLON BY NOLATTER THAN5 :00P .M., NEWY ORK CITY TIME ONM ARCH 30, 2009.E Rights carda nd calculation section for determ inin g your total deposit amount.F PLEASE SIGN INB OX 6 TO CERTIFY YOUR TAXPAYER ID OR SOCIA L SECURITY NUMBER fi you are a U.S.Taxpayer.If the Taxpayer D I or Social Securit y Number is incorrect or blank, insert or write th ecorrected number in Box 6 and sign to certify. You must cross-out item 2 therein if you have beennotified by the Inte rnal Revenue Service that you are currently subject to backup with holdingbecause you havef ailed to report all in e t rest and dividends ony our tax return. Please notethat BNY Mellon Shareowner Services may with hold 28% of your proceeds as required by the IRS ifthe Taxpayer ID or Social Security Number is not certi if ed on our records. If youa re a non - U.S . Taxpayer, please complete and return form W-8BEN or other appli cablew ithholding form. w Ify ouare surrendering ADS Rights for delivery of underl ying ordinary share rights, please comple e t Box 7 with details of a U.K. securi it es account o t which those share rights can be delivered. Inorder not to delay the credit of rights into your CREST account, please provid e receive instr uctions to CREST o t accept a deliv ery of rights from BO011 for the quantity of rights subscribed.THIS ADS RIGHTS OFFERING HAS BEEN QUALIFIED OR IS BELIEVED TO BE EXEMPT FROM QUALIFICATION ONLYUNDER THE FEDERAL LAWS OF THE UNITED STATES AND THE LAWS OF THE STATES IN THE UNITED STATES.RESIDENTSO F OTHER JURIS DICTIONS MAY NOT PURCHASE THE SECURITIES OFFERED HEREBY UNLESS THEYCERTIFY THAT THEIR PURCHASES OF SUCH SECURITIES ARE EFFECTED IN ACCORDANCE WITH THE APPLICABLE LAWSOF SUCH JURISDICTIONS.OPTION 4 ABOVE EXPIRES AT 5:00 P.M.,N EWY ORK CITY TIME, ON MARCH 30, 2009.THIS ADS RIGHTS OFFERING EXPIRES AT 5:00 P.M., NEW YORK CITY TIME, ON MARCH 31, 2009 AND THISSUBSCRIPTION CERTIFICATE